Mucksavage Jeffrey J, He Kevin J, Chang James, Panlilio-Villanueva Maria, Wang Tianxiu, Fraidenburg Dustin, Benken Scott T
Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL.
Department of Nursing, University of Illinois Health, Chicago, IL.
Crit Care Explor. 2020 Sep 25;2(10):e0204. doi: 10.1097/CCE.0000000000000204. eCollection 2020 Oct.
A validated means to predict inhospital cardiac arrest is lacking. The purpose of this study was to evaluate the changes in end-tidal carbon dioxide, as it correlates with the progression to inhospital cardiac arrest in ICU patients.
Single-center, retrospective cohort study of mechanically ventilated ICU patients (age > 18 yr old) having inhospital cardiac arrest with advanced cardiac life support and continuous end-tidal carbon dioxide monitoring at a single academic center from 2014 to 2017. Demographics, clinical variables, and outcomes were collected. End-tidal carbon dioxide was collected from 5 to 2,880 minutes before inhospital cardiac arrest. Data were analyzed using descriptive statistics, and model estimates were generated using a repeated-measures categorical model with restricted maximum likelihood estimation and fully specified (autoregressive) covariance to assess the effect of time on changes in end-tidal carbon dioxide.
A total of 788 patients were identified and 104 met inclusion criteria, where 62% were male with an average age of 58.5 years. Seventy-four percent required vasopressors and 72% experienced pulseless electrical activity. Mean end-tidal carbon dioxide 5 minutes prior to inhospital cardiac arrest was significantly lower than all evaluated time points except 180 minutes ( < 0.05). One patient survived to hospital discharge. In multivariate logistic regression modeling for return of spontaneous circulation, a greater change in the prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum was associated with a decreased likelihood of return of spontaneous circulation (odds ratio 0.903; 95% CI, 0.832-0.979; = 0.014). Additionally, a change from prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum greater than 17 mm Hg was associated with a decreased likelihood of return of spontaneous circulation and odds ratio 0.150; 95% CI, 0.036-0.66; = 0.012).
Mean end-tidal carbon dioxide is significantly lower immediately before inhospital cardiac arrest. The statistical and clinical significance of end-tidal carbon dioxide may highlight its utility for predicting inhospital cardiac arrest in ICU patients. Comparison analysis and modeling explorations in a larger cohort are needed.
目前缺乏一种经过验证的预测院内心脏骤停的方法。本研究的目的是评估呼气末二氧化碳的变化，因为它与重症监护病房（ICU）患者发生院内心脏骤停的进展相关。
设计、设置与患者：对2014年至2017年在单一学术中心接受高级心脏生命支持和持续呼气末二氧化碳监测的机械通气ICU患者（年龄>18岁）进行单中心回顾性队列研究。收集人口统计学、临床变量和结局数据。在院内心脏骤停前5至2880分钟收集呼气末二氧化碳数据。使用描述性统计分析数据，并使用具有受限最大似然估计和完全指定（自回归）协方差的重复测量分类模型生成模型估计值，以评估时间对呼气末二氧化碳变化的影响。
共识别出788例患者，104例符合纳入标准，其中62%为男性，平均年龄58.5岁。74%的患者需要血管加压药，72%的患者出现无脉电活动。院内心脏骤停前5分钟的平均呼气末二氧化碳显著低于除180分钟外的所有评估时间点（P<0.05）。1例患者存活至出院。在多变量逻辑回归模型中，用于预测自主循环恢复情况时，心脏骤停前呼气末二氧化碳最大值与心脏骤停前呼气末二氧化碳最小值之间的变化越大，自主循环恢复的可能性越低（比值比0.903；95%可信区间，0.832 - 0.979；P = 0.014）。此外，心脏骤停前呼气末二氧化碳最大值与心脏骤停前呼气末二氧化碳最小值之间的变化大于17 mmHg与自主循环恢复的可能性降低相关，比值比为0.150；95%可信区间，0.036 - 0.66；P = 0.012）。
院内心脏骤停前即刻的平均呼气末二氧化碳显著降低。呼气末二氧化碳的统计学和临床意义可能突出了其在预测ICU患者院内心脏骤停方面的效用。需要在更大的队列中进行比较分析和模型探索。
